California Court absolves Kaiser of paying for Viagra. (Companies).A California Court of Appeals has ruled that the California Department of Managed Health Care didn't have the authority to order Kaiser Permanente Kaiser Permanente is an integrated managed care organization, based in Oakland, California, founded in 1945 by industrialist Henry J. Kaiser and physician Sidney R. Garfield. to provide coverage for prescription drugs to treat sexual dysfunction sexual dysfunction Inability to experience arousal or achieve sexual satisfaction under ordinary circumstances, as a result of psychological or physiological problems. , including Viagra. The Department of Managed Health Care, as a result of regulation that said every health maintenance organization must provide medically necessary medically necessary Managed care adjective Referring to a covered service or treatment that is absolutely necessary to protect and enhance the health status of a Pt, and could adversely affect the Pt's condition if omitted, in accordance with accepted drugs, had ordered the insurer to provide the coverage, according to according to prep. 1. As stated or indicated by; on the authority of: according to historians. 2. In keeping with: according to instructions. 3. court papers. The department won't appeal again, said Steven Fisher, deputy director. Kaiser feels "vindicated" by the ruling, said Anthony Barrueta, senior counsel for the insurer. When Viagra came onto the market, there was tremendous concern the cost would be so high it would crowd out coverage of other drugs, Barrueta said. Viagra, which treats erectile dysfunction Erectile Dysfunction Definition Erectile dysfunction (ED), formerly known as impotence, is the inability to achieve or maintain an erection long enough to engage in sexual intercourse. , has been cited as one of the drivers of pharmaceutical cost increases for insurers. Anthem Inc. has said its commercial members with more than 50 employees have had to pay more to keep Viagra on its covered prescription drug list. Health plans in California aren't required to cover prescription drugs at all, Barrueta said. But if plans do offer drug benefits, the Knox-Keene Health Service Plan Act said they must offer pain medications for the terminally ill Terminally Ill When a person is not expected to live more than 12 months. Notes: Any gifts given out by the afflicted person at this time may be considered as a dispersion of the estate rather than a gift. , diabetes drugs, contraception and drugs for life-threatening conditions. The case brings up the issue of which drugs are considered medically necessary, said Walter Zellman, president of the California Association of Health Plans. "If you write a law that says HMOs must cover all medically necessary drugs, it's not always clear what is medically necessary and what isn't" he said. |
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